Squizzato A, Romualdi E, Büller H R, Gerdes V E A
Department of Clinical Medicine, University of Insubria, Varese, Italy.
J Clin Endocrinol Metab. 2007 Jul;92(7):2415-20. doi: 10.1210/jc.2007-0199. Epub 2007 Apr 17.
Various changes in the coagulation-fibrinolytic system have been described in patients with an excess or deficiency of thyroid hormones. The purpose of this systematic review is to summarize the effects of hyperthyroidism and hypothyroidism on these systems.
All published case-control or interventional cohort studies that evaluated the effects of hyperthyroidism and hypothyroidism on the coagulation-fibrinolytic system in vivo were identified by a computer-assisted search of the MEDLINE and EMBASE electronic databases. A scoring system was used to divide studies into three quality categories: high, medium, and low quality.
A total of 36 papers were included. Because in several papers more than one case-control study or both a case-control and intervention study were described, a total of 39 case-control studies and 24 interventional cohort studies were analyzed. No high-quality study was identified. Three (7.7%) case-control and eight (33.3%) cohort studies were of medium quality. A total of 19 tests were investigated in the medium-quality studies. These tests revealed a hypocoagulable state for overt hypothyroidism and a hypercoagulable state for overt hyperthyroidism.
This analysis confirmed that clinically overt hyperthyroidism and hypothyroidism modify the coagulation-fibrinolytic balance, indicating that thyroid hormone excess or deficit is the probable main pathophysiological mechanism. Patients with overt hypothyroidism and overt hyperthyroidism appear to have an increased risk of bleeding and of thrombosis, respectively.
甲状腺激素过多或过少的患者凝血-纤溶系统会出现多种变化。本系统评价的目的是总结甲状腺功能亢进和减退对这些系统的影响。
通过计算机辅助检索MEDLINE和EMBASE电子数据库,识别出所有已发表的评估甲状腺功能亢进和减退对体内凝血-纤溶系统影响的病例对照研究或干预队列研究。采用评分系统将研究分为三个质量类别:高质量、中等质量和低质量。
共纳入36篇论文。由于几篇论文中描述了不止一项病例对照研究,或同时描述了病例对照研究和干预研究,因此共分析了39项病例对照研究和24项干预队列研究。未识别出高质量研究。三项(7.7%)病例对照研究和八项(33.3%)队列研究为中等质量。在中等质量研究中总共调查了19项检测。这些检测显示,显性甲状腺功能减退时处于低凝状态,显性甲状腺功能亢进时处于高凝状态。
该分析证实,临床显性甲状腺功能亢进和减退会改变凝血-纤溶平衡,表明甲状腺激素过多或过少可能是主要的病理生理机制。显性甲状腺功能减退和显性甲状腺功能亢进患者分别似乎有出血和血栓形成风险增加的情况。